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Providing better care when you need it most
The emergency room (ER) can be an extremely busy place. The Centers for Disease Control and Prevention found that there are 136.3 million emergency department visits each year in the United States, with the south having one of the highest population-based visit rates. With such high volume, patients can easily feel lost or forgotten in the crowd.
“At the end of the day, all patients really care about is getting quality care within a reasonable time frame,” said Michael Waterman, division director, performance excellence at KentuckyOne Health. “While we were having some successes, we knew we could improve and that our patients deserved better.”
A look at the ER data from all KentuckyOne Health facilities revealed opportunities to improve care and enhance the patient experience. One of the most telling numbers came from the “left without being seen” (LWBS) rates – a number that represents patients who leave the ER before getting help due to long waits.
“The worst kind of care is no care at all,” Waterman said. “Our LWBS rates showed that people from our communities were coming in and leaving before we could get to them. That wasn’t acceptable, and we knew there had to be a better way.”
In February 2016, the first KentuckyOne Health facility, Sts. Mary & Elizabeth Hospital, began its ER redesign with $9 million from the Jewish Hospital and St. Mary’s Foundation. The process started by bringing in consultants who had worked with more than 200 ERs across North America.
“We saw where there were certain holes in our processes that provided us with opportunities for improvement,” Waterman said. “We just needed a tried-and-true template to get us moving in the right direction.”
After seeing improved outcomes within the Sts. Mary & Elizabeth Hospital ER, the decision was made in March to begin redesigning the ER in each KentuckyOne Health facility. Every ER went through a four-day process to initiate the transformation.
Day 1: Analysis
The hospital supplied a multidisciplinary team to analyze the current state of their ER. They reviewed what was done well, what could be improved upon and future goals.
Then, the department went through a “lean” process, where the team examined their current procedures and pointed out any step that didn’t add any value or contribute to meeting patients’ needs.
“When we sent the teams to review their own processes, it quickly became apparent that many of the steps, such as asking people for their information multiple times, were adding no value,” Waterman said. “By cutting this waste, we could drastically reduce the time necessary to see patients, treat them and send them on their way.”
Day 2: Redesign
The redesign process was modeled after the Sts. Mary & Elizabeth Hospital ER. However, each site modified the original plan to make it better match their setup. These modifications came from feedback from every member of the department. At Jewish Hospital and Sts. Mary & Elizabeth Hospital, Jewish Hospital and Sts. Mary’s Foundation provided funding for expansions and remodeling.
“All team members were involved with tweaking the processes to match their site,” said Jennifer Nolan, president, Sts. Mary & Elizabeth Hospital and Our Lady of Peace. “this wasn’t something that was being done to them by some outside force. It was an opportunity to control their own future as a department.”
Days 3 & 4: Testing
Once the redesigned process was created, the hospital teams tested it. Modifications were made as needed and then the entire process was tested again.
“A great part of this process is we collected data in real time,” Nolan said. “So we could immediately see if our goals were being met and then make process changes, if necessary.”
The results of this four-day process across the entire system have been promising.
“Based on some preliminary data, we can see patients’ experiences are improving,” Waterman said. “Regarding LWBS, we have seen a range of results with reduction from 15 to 63 percents. The time from when a patient arrives to seeing a provider [physician or nurse practitioner] has decreased 38 percent on average across all our locations. The length of stay is also down by an average of 17 percents, and in some locations, it’s been reduced more than 30 percent.”
Regardless of how things are going, the ER teams meet every day to discuss the previous day’s performance and ideas of how to continuously improve.
“The future only looks brighter for our ERs,” Waterman said. “We allowed those in the department to make the process their own and put structures in place to provide them help and suggestions when they need it.”
This article originally appeared in the Fall 2016 edition of One Health Magazine. For the latest news on KentuckyOne Health, visit our News Center and read more about our 30-minute ER pledge.